RESUMO
OBJECTIVES: The goals of this study were to assess late clinical outcome and left ventricular ejection fraction (LVEF) after transmyocardial revascularization with CO(2) laser (TMR). BACKGROUND: During the 1990s TMR emerged as a treatment option for patients with refractory angina not eligible for conventional revascularization. Few reports exist on clinical effects and LVEF >3 years after TMR. METHODS: One hundred patients with refractory angina not eligible for conventional revascularization were block-randomized 1:1 to receive continued medical treatment or medical treatment combined with TMR. The patients were evaluated at baseline and after 3, 12 and 43 (range: 32 to 60) months with end points to angina, hospitalizations due to acute myocardial infarctions or unstable angina, heart failure and LVEF. Mortality was registered and MOS 36 Short-Form Health Survey answered at baseline and after 3, 6 and 12 months. RESULTS: Forty-three months after TMR, angina symptoms were still significantly improved, and unstable angina hospitalizations reduced by 55% (p < 0.001). Heart failure treatment (p < 0.01) increased, whereas the number of acute myocardial infarctions, LVEF and mortality was not affected. Quality of life was improved 3, 6 and 12 months after TMR. CONCLUSIONS: Forty-three months after TMR, angina symptoms and hospitalizations due to unstable angina were significantly reduced, heart failure treatment increased and LVEF and mortality were seemingly unaffected.
Assuntos
Angina Pectoris/cirurgia , Doença das Coronárias/cirurgia , Terapia a Laser/métodos , Revascularização Miocárdica/métodos , Disfunção Ventricular Esquerda/cirurgia , Idoso , Angina Pectoris/mortalidade , Doença das Coronárias/mortalidade , Feminino , Seguimentos , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Qualidade de Vida , Taxa de Sobrevida , Disfunção Ventricular Esquerda/mortalidadeRESUMO
UNLABELLED: In all reported clinical studies with (18)F-FDG-labeled leukocytes, heparin was used as an anticoagulant during labeling. Theoretically, the substitution of heparin with citrate should be advantageous. METHODS: Blood from healthy controls was sampled in duplicate, anticoagulated with citrate or heparin, and labeled with (18)F-FDG, and the labeling yield was measured. Viability was checked with the trypan blue exclusion technique. Moreover, 4 in vivo PET/CT studies were performed after the reinjection of leukocytes labeled after citrate anticoagulation. RESULTS: The labeling yields obtained with citrate and heparin were not significantly different (P = 0.447). Viability was greater than or equal to 99%. The quality of the PET/CT studies was excellent. In the in vivo studies, the mean labeling yield was 78%-better than or equal to that reported with heparin as an anticoagulant. CONCLUSION: Citrate is at least as effective as heparin as an anticoagulant, does not (unlike heparin) increase granulocyte activation, and should be the preferred anticoagulant for (18)F-FDG labeling of leukocytes.